Prescribing the Right Diabetes Medications

Hey guys! Here recently, I’ve gotten a lot of questions over prescribing. Questions regarding what’s next after metformin…what meds to combine in dual and triple therapy…how to advance insulin… this is just the tip of the iceberg. I thought it would be good to focus on the nurse practitioner’s mindset and what we should consider when prescribing medications for diabetes. Now keep in mind that this is not an all inclusive list and I am not discussing individual medications or classes with this post. If by chance you need a refresher over the drug classes, I made a playlist for diabetes treatment over on my YouTube channel, Kim E. The Diabetes NP. You can watch it >HERE<

Back to the prescribing considerations…I came up with a list of seven questions that you can ask yourself when making a decision over what medication would be good for your diabetic patient.

1. Which glucose level will be targeted?

   Is the Fasting blood glucose or Postprandial glucose or BOTH? There are medications that target a specific one.

2. How much will the medication lower the Hgb A1c?

   You may have a patient that is mildly diabetic or one that has a ways to go before getting to goal. You want to get the most bang for your buck so considering this will help you choose the most appropriate medication.

3. What is the patient’s PREFERRED route of administration?

   Let’s be honest…some people, a lot of people have an aversion to needles. It’s always good to know this because if a patient is strongly against sticking themselves, chances are they are not going to be adherent to the treatment.

4. What is the risk of HYPOGLYCEMIA?

   Very important to note! Some meds induce hypoglycemia and some in combination with others can induce it. As a prescriber, you would need to know that.

5. What is the Cost of medication?

   If a patient can’t afford it, they are not going to get it. This is frustrating especially when you know a medication will do the job but unfortunately this is what we have to deal with. Medications are expensive & patients on fixed incomes or from low socioeconomic classes get the brunt of this.

6. What is the medication’s Side Effects Profile?

   Here’s another place where non-compliance can occur. Patients will stop what they can’t tolerate and honestly some of the meds bring about some pretty serious side effects so knowing that plus the patient’s history is pertinent.

7. What co-morbidities does the patient have?

   Lastly, if a patient has many chronic illnesses, some of the medications can exacerbate them. We definitely don’t want that

Of course you know I made a video to go with this post and it goes more into detail over each point. I’ll link it below and the NP DIABETES STARTER PACK as well that has lots of FREE cheat sheets and guides that cover the foundation of DIABETES MANAGEMENT!